Name of the Student:
Nationality: Gender:
Contact No:   E-mail Id:  
Permanent Address: Present Address:
City: City:
State: State:
Pin: Pin:
Course Name: Year/Semester:
University Registration No,: College Roll No:
  Year of Study Session:  
Date of the Problem or Incident: Description of the Problem or Incident:
  Where you ever ragged: Did you ever rag anybody:  
Enter The Answer bellow: (11 + 0 = )